Getting off of PPI drugs

I have nighttime GERD (possibly NERD as several endoscopies and no erosion evidence).  I do not have symptoms during the day, only at night. I've made all the lifestyle changes, elevated bed, not eating after 6:pm, I'm slender, don't drink, don't smoke, exercise, eat healthy.  I've been on Protonix for several years, recently my dosage was upped to two 40 Mgs per day.  Still not totally asymptomatic at night.  My doctor has repeatedly assured me of the safety of this class of drugs..said people take them, safely, for years.  After reading the latest research, increased risk of fractures, lack of hydrocloric acid increasing the risk of infection from certain types of bacteria, etc.  I've tried taking myself off this drug, but to no avail.  Longest I last is about 4 days.  Symptoms occur at night and my sleep becomes very fragmented, thus I'm a zombie the next day.  What is the current medical wisdom concerning PPI's in light of the latest studies?  Is there a "step down" therapy?  What about Esophyx?

[Ratnakar Kini, MD]

Hi,
PPI are very safe and effective medications for GERD. But they are not very effective for nighttime symptoms.
For nighttime symptoms you need to take H2RA like Zantac at bedtime.